Home care as an alternative to hospitalization: a case study in Belgium

In Belgium, primary health care services are well developed. Their efficiency is, however, handicapped by a general lack of coordination at a local level. Recently, pilot projects have been conducted to improve the integration of the various activities related to the practice of family medicine and especially those activities associated with the home care of chronic diseases and disabilities of the elderly. In one municipality where the coordination of primary care services is organized from a health centre, a retrospective study was carried out to measure the possible effect of such coordination on the use of health services. Indicators of the use of medical services were measured before and after the establishment of the coordinating centre, and were compared with the evolution observed in control areas. It is shown that the establishment of a health centre and the coordination of existing activities do not result in an inflationary use of primary care services. Moreover, the use of secondary care services seems to be reduced, indicating a net benefit in terms of costs.